Provider Demographics
NPI:1225273188
Name:MARSHALL, LISA DIANE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DIANE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5623 S. QUEBEC AVENUE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4231
Mailing Address - Country:US
Mailing Address - Phone:918-494-2970
Mailing Address - Fax:
Practice Address - Street 1:5623 S QUEBEC AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-4231
Practice Address - Country:US
Practice Address - Phone:918-494-2970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2444235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist